Kenalog/steroid atrophy 1.5 years later, will this eventually go away? (Photos)

Question

Hello. The first photo is when I first got the Kenalog atrophy and the second photo is 1.5 years later (now). Does anyone know if this will eventually go away or do I have to suffer with this dent on my face forever? Thank you.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I'm sorry that this has happened to you. In general, steroid injection induced indentations will improve significantly within six months following the treatment. However, in some cases the indentation can remain indefinitely. This may result from the use of too much and/or too highly concentrated amounts of steroid injected to treat the problem. Often, however, particularly in cases of treating inflamed cysts, such as acne cysts, the indentation is more the result of the intralesional steroid injections being given too late. You see, there is a window of time between 9-14 days (max 21) during which the intralesional steroid should be given to bring down the active inflammation. When this window is passed, there is a good chance for the development of an indented scar. So, perhaps if in this case, the indentation was injected with the steroid after this critical window of time, the indentation is more the result of delay in treatment, rather than the treatment itself. 
In either case, take a breath. Help is on the way. Subcision, which I have personally been performing for nearly thirty years with gratifying results, is a simple, inexpensive and proven safe and effective means for elevating and smoothing indentations from all causes. It is often combined with the use of an HA filler for added benefit. You would be wise to consult with a board certified cosmetic dermatologist. Hope this helps and Best of luck.

Anna Chacon, MD, FAAD · Answer

Kenalog (triamcinolone acetonide) is a corticosteroid often used to treat inflammation and various dermatological conditions. One of the potential side effects of intralesional Kenalog injections is steroid atrophy, which is the thinning of the skin and underlying tissues at the injection site. This can result in a visible dent or depression in the skin.

Steroid atrophy can be distressing, especially when it occurs on the face. The improvement of steroid atrophy over time can vary significantly from person to person. Here are some key points to consider:

1. **Natural Recovery**: In many cases, steroid atrophy can improve over time as the skin and subcutaneous tissues slowly regenerate. However, this process can be very slow and may not result in complete resolution.

2. **Duration**: Since you mentioned that it has been 1.5 years since the atrophy occurred, the likelihood of significant natural improvement diminishes over time. Some patients do see gradual improvement beyond this timeframe, but it can be unpredictable.

3. **Treatment Options**:
   - **Topical Treatments**: Some topical treatments, such as tretinoin (a form of vitamin A) or other retinoids, may help stimulate collagen production and improve skin texture over time.
   - **Dermal Fillers**: For more immediate improvement, dermal fillers can be used to fill in the depressed area. Hyaluronic acid fillers are commonly used for this purpose and can provide temporary correction.
   - **Microneedling**: This procedure involves tiny needles creating micro-injuries in the skin, which can stimulate collagen production and improve skin texture over time.
   - **Platelet-Rich Plasma (PRP)**: PRP therapy involves using your own blood plasma, which is rich in growth factors, to promote healing and tissue regeneration.
   - **Laser Therapy**: Certain laser treatments can help stimulate collagen production and improve the appearance of atrophic scars or depressions.

4. **Consultation with a Specialist**: It is essential to consult with a dermatologist or a plastic surgeon who specializes in cosmetic procedures. They can assess the extent of the atrophy and recommend the most appropriate treatment options based on your specific situation.

5. **Preventive Measures**: If you require future corticosteroid injections, discuss with your healthcare provider about using the lowest effective dose and possibly diluting the steroid to minimize the risk of atrophy.

In summary, while some individuals may see gradual improvement in steroid atrophy over time, others may require intervention to achieve desired cosmetic results. Consulting with a specialist will provide you with the best guidance and treatment options tailored to your needs.

Kenalog/steroid atrophy 1.5 years later, will this eventually go away? (Photos)

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Kenalog/steroid atrophy 1.5 years later, will this eventually go away? (Photos)

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